MEDICARE: GERALDINE A. GOMEZ LPC-S, ATR-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	74350	TX
2	101YP2500X	Professional Counselor	74350	TX

General Provider Information

NPI Number	:	1356858302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERALDINE A. GOMEZ LPC-S, ATR-BC

Provider Business Mailing Address
First Line	:	10401 S MASON RD
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77406-5885
Country	:	US
Telephone Number	:	346-758-1812
Fax Number	:

Provider Business Practice Location Address
First Line	:	10401 S MASON RD
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77406-5885
Country	:	US
Telephone Number	:	346-758-1812
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2017
Last Update Date	:	09/21/2022

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